Hip Pain (cont.)
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Hip Pain Diagnosis
Making the diagnosis of the cause of hip pain begins with the health-care professional talking with the patient, or their family, or caregivers and taking a careful history of the what, where, and when of the pain as well as reviewing any other underlying complaints. By factoring in the past medical history of the patient, the health-care professional can make a differential diagnosis or list of what potential causes might be considered. The physical examination helps refine that list, and tests may be done to confirm a specific diagnosis.
Sometimes the diagnosis is evident. The patient fell, hurt their hip, can't bear weight, and X-rays show a fractured hip. Sometimes the diagnosis requires more searching and may take time and repeat visits to find the source of the hip pain.
The history may involve many questions regarding everything from the onset of the hip pain to what makes it better or worse. The goal is for the provider to understand the frequency, duration, and context of the pain in relationship to the daily activities of the patient.
Aside from the history of the pain, other information looking for a systemic illness may be helpful in finding the cause of pain. Has there been an injury? Has there been a history of fever or chills? Weight loss? Abdominal pain? Diarrhea? Do other joints hurt or swell? While the questions may seem unrelated to the hip, it is necessary for the health-care professional to consider all possibilities. A review of past medical history, including medications, may give direction to assessing the situation.
Physical examination for hip pain most often will focus on the hip, leg, and back, however, the rest of the body will not be ignored; looking for associated findings may help explain the patient's complaints.
Observation of the hip at rest and while standing or walking, palpation (or feeling) of the hip and surrounding structures, testing for range of motion and strength, and checking for sensation and pulses all may be appropriate.
Many times plain X-rays of the hip and pelvis are done to look at the bones and the joint spaces. In a fall, this may diagnose an acute fracture, but occasionally, the break cannot be seen on routine films. If the suspicion for fracture is high, computerized tomography (CT) or magnetic resonance (MRI) imaging may be considered to confirm or disprove that a fracture is present.
Narrowed joint spaces and arthritis can be seen on plain X-rays and help confirm the diagnosis of osteoarthritis and degenerative joint disease.
When looking for cartilage or labrum tears in the hip, an arthrogram may be done, in which a radiologist injects contrast dye into the hip joint using a long thin needle. Either plain X-rays or MRI images are taken to look at the joint surfaces outlined by the dye. With either test, a local anesthetic is injected prior to the dye. It is helpful to know if the anesthetic resolves the pain, because if so, it may confirm that the source of the pain is from within the joint.
A bone scan may be performed to look for inflammation. Radioactive dye is injected intravenously and the whole body is scanned. The radiologist looks for abnormal accumulations of the dye that may help establish a diagnosis. This might be helpful in determining whether it is a single hip joint that is involved or whether multiple parts of the body are also inflamed.
If the health-care professional is concerned that a systemic (body-wide) illness is the cause of the hip pain, blood tests may be ordered. Some markers for inflammation include elevation of the white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). These are nonspecific tests but can help direct further testing based upon the clinical situation. A white blood cell count may also be helpful as a screening test for infection and inflammation.
Medically Reviewed by a Doctor on 4/10/2014
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